Toita Takafumi
Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan.
Int J Clin Oncol. 2009 Feb;14(1):25-30. doi: 10.1007/s10147-008-0865-0. Epub 2009 Feb 20.
Standard definitive radiotherapy for cervical cancer consists of whole pelvic external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT). In Japan, high-dose-rate ICBT (HDR-ICBT) has been utilized in clinical practice for more than 40 years. Several randomized clinical trials demonstrated that HDR-ICBT achieved comparative outcomes, both for pelvic control and incidences of late complications, to low-dose-rate (LDR) ICBT. In addition, HDR-ICBT has some potential advantages over LDR-ICBT, leading to further improvement in treatment results. Prior to the current computer planning systems, some excellent treatment planning concepts were established. At present, systems modified from these concepts, or novel approaches, such as image-guided brachytherapy (IGBT) are under investigation. One serious problem to be solved in HDR-ICBT for cervical cancer is that of the discrepancy in standard treatment schedules for combination HDR-ICBT and EBRT between the United States and Japan. Prospective studies are ongoing to assess the efficacy and toxicity of the Japanese schedule.
宫颈癌的标准根治性放疗包括全盆腔外照射放疗（EBRT）和腔内近距离放疗（ICBT）。在日本，高剂量率腔内近距离放疗（HDR-ICBT）已在临床实践中应用了40多年。多项随机临床试验表明，HDR-ICBT在盆腔控制和晚期并发症发生率方面取得了与低剂量率（LDR）ICBT相当的结果。此外，HDR-ICBT相对于LDR-ICBT具有一些潜在优势，从而进一步改善了治疗效果。在当前的计算机治疗计划系统出现之前，就已经确立了一些出色的治疗计划概念。目前，基于这些概念改进的系统或诸如图像引导近距离放疗（IGBT）等新方法正在研究中。在宫颈癌的HDR-ICBT中，一个亟待解决的严重问题是美国和日本在HDR-ICBT与EBRT联合治疗的标准治疗方案上存在差异。目前正在进行前瞻性研究，以评估日本方案的疗效和毒性。
